Connecticut Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
Health Reinsurance Association of Connecticut / HRAC

Insurance Regulation Establishing Risk Pool
Connecticut Insurance Department
Connecticut Health Care Act of 1975 – Chapter 700c, Sec. 38a-556

The Health Reinsurance Association (HRA)

The Health Reinsurance Association (HRA), created by the Connecticut Health Care Act of 1975, offers coverage to individuals who have been rejected for individual policies because of pre-existing health conditions. HRA also covers ‘HIPAA eligible individuals’ who have left group health coverage AND fully exhausted all COBRA or state continuation coverage for which they are eligible. Basically, the HRA is a high risk pool for Connecticut residents who are older than the age of 19 and under the age of 65. The program offers health insurance coverage to individuals at subsidized rates through licensed Connecticut HMOs and private insurance companies.

Funding

The HRA is partially funded by the premium payments that are collected from enrolled participants. Deficits in the program are funded through an assessment of the insurance companies that operate in Connecticut, and there is not tax offset.

Plans Offered

The HRA offers a choice of three plans comparable to plans offered to small employers: HMO coverage, PPO coverage and a Special Health Care Plan. Any health insurance company conducting business in the State of Connecticut must provide a comprehensive individual health plan available to all residents of the state, regardless of their health status. This does not apply to residents of the age of 65 or that qualify for Medicare. There are 3 types of plans available under HRA, 1) individual plans, 2) conversion plans and 3) portability plans. Each of these plans has two options, which are the Special Health Care plan (SCHP) and the United HealthCare PPO plan. A TAA qualified plan is also available on the individual and portability plans. HMO coverage is available for the conversion and portability plans.

Plan Benefits

The United Health Care PPO has $1,500 annual deductible and pays 80% of most covered medical expenses after the deductible has been met. The annual out-of-pocket maximum is $7,500 in-network and $15,000 out-of-network. A separate deductible applies to prescription drugs, after which there is a set co-payment. The Special Health Care Plan will pay 75% of the Medicare reimbursement level after the plan member meets the annual deductible. The Medicare Reimbursement Level is based on the amount that could be paid under the Federal Medicare Program. The deductible you are required to pay is based on your income level. The annual out-of-pocket maximum is $2,500. The HMO has no annual deductible, $25 office visits, a $250 (first 4 days) per day hospital co-payment and set co-payments for prescription drugs. The annual out-of-pocket limit for HMO plan is $5,000 per individual.

HRA Brochures

Maximum Benefit Limits

The maximum payable lifetime benefits per insured HRA member for all of the plan types offered is $1,500,000. Some covered benefits under the plan are subject to annual maximum benefits.

Eligibility

There are different eligibility requirements, based on the type of HRA plan for which you are applying. For all plans, you must be a resident of Connecticut and between the ages of 19 and 65.

Individual Plans

The plan options are the Special Health Care plan and the UNITEDHealthCare PPO plan. Individual Plans have a 12 month waiting period for any pre-existing medical condition.

• If you have not had group or qualifying individual insurance coverage in the last 150 days, you may enroll in these plans.
• You are eligible for one of the Special Health Care plans depending on your adjusted gross income and the size of your family.

Conversion Plans

The plan options are the Special Health Care Conversion plan, the UNITEDHealthCare PPO Conversion plan, and the Health Net HMO Conversion plan. These plans will cover pre-existing conditions immediately. You may be eligible for these plans provided:

• You have had employer group coverage, or qualifying coverage such as group health insurance plan, Medicaid, individual health plan, for at least 12 months.
• Your application and premium are received in our office within 120 days of the end of your prior health insurance plan due to voluntary loss of coverage or 150 days of the end of your coverage due to involuntary loss of coverage. The HRA plan will begin coverage the 1st of the month following receipt of a completed application.

HMO Conversion Plan

• You are a resident of Connecticut under the age of 65.
• You have had continuous coverage for at least 12 months.
• Your application is received in our office within 120 days of the end of your prior health insurance plan due to voluntary loss of coverage or 150 days of the end of your prior health insurance plan due to involuntary loss of coverage. The HRA plan will begin coverage the 1st of the month following receipt of a completed application.

SCHP Conversion Plan

• You are a resident of Connecticut under the age of 65.
• You have had continuous coverage for at least 12 months.
• Your application is received in our office within 120 days of the end of your prior health insurance plan due to voluntary loss of coverage or 150 days of the end of your prior health insurance plan due to involuntary loss of coverage. The HRA plan will begin coverage the 1st of the month following receipt of a completed application.
• You are eligible for one of the Special Health Care plans depending on your adjusted gross income and the size of your family.
• To qualify for the Low Income Plan your adjusted gross income from the prior year must be equal to or less than 300% of the federal poverty level.
• You must submit the Federal Tax return with your application as verification of low-income eligibility.

Portability Plans

The plan options are Special Health Care Portability plan, the UNITEDHealthCare PPO Portability plan, and the Health Net HMO Portability plan. These plans will also cover pre-existing conditions right away.

HMO Portability Plan

• All Connecticut residents under the age of 65. Connecticut residents who are over the age of 65 and are not covered under Medicare Part A & Part B
• Must have 18 months of prior continuous health insurance coverage with a gap of no more than 120 days (150 days if loss of insurance was due to loss of job)
• Your most recent active health insurance was through a group health plan
• Your application and premium are received in our office within 120 days of the end of your prior health insurance plan due to voluntary loss of coverage or 150 days of the end of your prior health insurance due to involuntary loss of coverage. The HRA plan will begin coverage the 1st of the month following receipt of a completed application.
• You are not eligible for continuation of coverage under COBRA regulations

SHCP Portability Plan

• All Connecticut residents under the age of 65. Connecticut residents who are over the age of 65 and are not covered under Medicare Part A & Part B.
• You have had continuous creditable coverage for at least 18 months.
• You are not eligible for or have exhausted other group health insurance coverage including COBRA, if it was offered to you.
• Your application and premium are received in our office within 120 days of the end of your prior health insurance plan due to voluntary loss of coverage or 150 days of the end of your prior health insurance plan due to involuntary loss of coverage. The HRA plan will begin coverage the 1st of the month following receipt of a completed application.
• You are eligible for one of the Special Health Care plans depending on your adjusted gross income and the size of your family.
• To qualify for the Low Income Plan, your adjusted gross income from the previous must be less than 300% of the federal poverty level.
• You must submit the Federal Tax return with your application as verification of low-income eligibility.

Enrollment Periods

Enrollment, in some cases, will apply to the type of coverage you are applying for under HRA. The individual plans do not have a restriction on when you can enroll, but the conversion plans and portability require that you submit an application within 120 days of voluntarily losing your prior health insurance coverage or 150 days of involuntary loss of coverage.

Premium Payments

Premiums are based on your plan selection, your gender and your age.

Premium Calculations

Monthly premiums are determined by looking at the standard risk premiums available for similar plans provided by private insurers at standard risk rates. Health plans available through the HRA must be at least 125% of the standard rates at initial enrollment or may not exceed 150% of this same rate.

Pre-Existing Condition Waiting Periods

The individual plans have a 12 month exclusionary period for pre-existing conditions. This exclusionary period is waived if you are eligible for the conversion plan or the portability pan.

Health Reinsurance Association of Connecticut Contact Information

Health Reinsurance Association
100 Great Meadow Rd., Suite 704
Wethersfield, CT 06109
Phone: 800-842-0004

HRA Website

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